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March 2014

Teledermatologic Care, the Affordable Care Act, and 20 Million New PatientsPicturing the Future

Author Affiliations
  • 1Perelman School of Medicine at the University of Pennsylvania, Philadelphia
  • 2Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia
  • 3Department of Dermatology, University of Pennsylvania, Philadelphia
  • 4Department of Medicine, University of Pennsylvania, Philadelphia
JAMA Dermatol. 2014;150(3):243-244. doi:10.1001/jamadermatol.2013.9603

There is considerable concern as to whether the current number of dermatologists in the United States can meet the needs of a growing patient population. The average wait time to see a dermatologist is already more than 30 days for new patients, and many practices are hiring nonphysician clinicians to fill the gap.1 Within the next 2 years, the Affordable Care Act’s individual health care mandate is expected to increase the number of nonelderly people with health insurance by more than 20 million, and this number could be substantially higher if many states elect to expand their Medicaid programs.2 Dermatologists will be faced with additional pressure to expand their practices and see more patients while the newly insured may be faced with a shortage of appointment availability and long wait times. The inability to access a board-certified dermatologist in a reasonable amount of time may force the newly insured to seek care from alternate providers or overburdened emergency departments or not receive care at all. Alternatively, these patients may use direct-to-patient teledermatologic services through the Internet or mobile devices that offer to evaluate skin issues quickly but may be unable to provide the continuity of care afforded by a physician-patient relationship. Newly insured patients, who are likely to be more racially diverse, less educated, and non-English speaking compared with the currently insured, may receive substandard dermatologic care from these alternative resources.3 These differences may ultimately lead to an increase in dermatologic health disparities and barriers of access in minority and vulnerable populations.

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